If you are interested in implementing the Heart of Many Nations: Heart Attack Prevention & Response in
Native Communities curriculum, in your community, please contact the Minnesota Department of Health at
651-201-5411.
© 2010 Minnesota Department of Health
This information can be made available in alternative formats, such as Braille, large print, or audio tape,
upon request.
Printed on recycled paper.
Contact information:
Mail:
Heart Disease and Stroke Prevention Unit
Attn: Heart of Many Nations
Center for Health Promotion
Health Promotion and Chronic Disease Division
P.O. Box 64882
St. Paul, MN 55164-0882
Phone: 651 201-5411
Fax:
651 201-5800
TTY:
651 201-5797
Website: www.health.state.mn.us/cvh
Acknowledgments
Funders
This curriculum was created by funding provided by the American Heart Association,
Midwest Affiliate, the Shakopee Mdewakanton Sioux Community, the Medica Foundation,
the Division for Heart Disease and Stroke Prevention, Centers for Disease Control and
Prevention, and the Minnesota Department of Health, Center for Health Promotion, Heart
Disease and Stroke Prevention Unit.
Project Partners and Community Advisory Committee
The Greater Minneapolis Council of Churches, Division of Indian Work staff provided significant
leadership and cultural expertise to develop this curriculum.
A Community Advisory Committee, consisting of the following community members and health care
professionals, provided invaluable knowledge and support to develop this curriculum. Those
members include:
Alameda Rocha, Community Leader
Adrienne Voorhees, Native American Community Clinic
Betty Moore, YWCA Minneapolis
Kateri Tuttle, Ain Dah Yung Center
Tammy Didion Heinicke, Indian Health Board
George Spears, Greater Minneapolis Council of Churches, Division of Indian Work
Suzanne Tibbetts Young, Greater Minneapolis Council of Churches, Division of Indian Work
Bob Klanderud, Greater Minneapolis Council of Churches, Division of Indian Work
The Heart Disease and Stroke Prevention Steering Committee also provided support and technical
expertise to create this project.
Curriculum Writer
Karen DeYoung, DeYoung Consulting Services, LLC
Contributing Author
Rosemary White Shield, Ph.D.
Illustrator
Robert Desjarlait
Disclaimer The Minnesota Department of Health is not able to provide individual
health advice. Please contact your medical care provider if you have specific questions
about your health.
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Table of Contents
Curriculum Overview...........................................................................................5
Curriculum Aim and Goals..........................................................................................................................5
Workshop Objectives..................................................................................................................................5
Trainer and Workshop Introduction ......................................................................6
Historical Trauma .........................................................................................................................................6
Healing from Historical Trauma ...........................................................................8
What is a Heart Attack?......................................................................................10
Signs and Symptoms..........................................................................................11
Calling 911.........................................................................................................13
Risk Factors ........................................................................................................15
Nutrition .............................................................................................................22
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Evaluation Instruments
Curriculum Overview
The Heart of Many Nations: Heart Attack Prevention and Response in Native Communities' curriculum
has been created with the input of advisors from within the American Heart Association, Minnesota
Department of Health, the Greater Minneapolis Council of Churches, Division of Indian Work and
other interested stakeholders (listed in acknowledgments). It is intended to present medical content
in a culturally relevant way, specific to Native communities.
This guide is designed to help you follow along during the heart attack awareness and
prevention session. It also eliminates the need for you to take lots of notes. There is plenty of space
for you to write your own notes. You are also encouraged to underline or highlight important points.
Curriculum Aim and Goals
The project’s curriculum aim is:
To promote and sustain the health and well being of Minnesota’s Native Communities.
The curriculum’s goals are to:

Increase Native communities’ awareness of the signs/symptoms of a heart attack;

Increase awareness of the importance of calling 911;

Increase Native communities’ awareness of heart health lifestyle practices; and,

Minimize disabilities and prevent deaths caused by heart attacks.
Workshop Objectives
As a result of this session you will be able to:
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
List the risk factors you can and cannot change that are associated with the likelihood of
having a heart attack.

List the signs and symptoms (in both men and women) associated with having a heart
attack.

List three examples of lifelong, heart healthy lifestyle practices.

Understand the importance of calling 911 if you believe someone is having a heart
attack or you believe you are having a heart attack.
Heart of Many Nations: Heart Attack Prevention and Response in Native Communities
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Introduction
In many of our Native traditions, we must seek healing whenever imbalance occurs in ourselves or
our communities. Many Native people view healing in a holistic way. Healing is a relationship
between the spiritual, mental, physical, and emotional aspects of a person. When one of these
aspects is out of balance, then the person becomes prone to illness.
Notes:
Historical Trauma
Colonization by European nations and others during the last few hundred years has led to an
imbalance in our communities by harming our tribal resources, including spiritual practices, oral
traditions, traditional foodways, and many others. This has caused historical trauma to Indian
people. Some of the things we've seen come into our Nations since the historical trauma include:

unhealthy family dynamics

poverty

loss of traditional values and spirituality

loss of Indian identity
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This imbalance in our communities has also resulted in the near destruction of traditional food
systems due to the loss of traditional lands; this includes a loss of animal herds, fish, plants, and
water sources.
Traditionally, we led an active Hunter-Gatherer lifestyle. Colonization of our people and our lands
has resulted in an imbalance in our communities and in ourselves. As our land shrank and we
became more sedentary, packaged foods, highly processed meats, and soda replaced gathered
plants, lean buffalo meat, and fresh water. With the changes in how we ate came diabetes,
obesity, and heart disease. Restoring a balance in how we nourish our bodies can create healing
and help prevent heart disease and heart attacks.
Notes:
Even though we are People of the heart, our community has been affected by heart disease:
1. Heart disease is the leading cause of death for American Indians in the United States, and in
Minnesota.
MDH Center for Health Statistics
2. In Minnesota, death rates due to heart disease are higher in American Indians than in any other
racial or ethnic group.
MDH Center for Health Statistics
3. A study of American Indian women in Minnesota shows only two-thirds would seek immediate
medical care when experiencing crushing chest pain, one of the most important signs of heart
attack.
Struthers, R., Savik, K., & Hodge, F.S. (2004) J Cardiovasc Nurs
4. The Indian Health Service (IHS) reports that the Bemidji district (which includes Minnesota) has the
second-highest death rate due to coronary heart disease of all 13 IHS regions across the United
States.
U.S. Department Health and Human Services, IHS
5. A national study of heart attacks shows that American Indians, especially living in rural areas,
have the longest time to treatment after symptoms begin of any racial or ethnic group.
Canto JG, et al. (1998). Am J Cardiol.
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Healing from Historical Trauma
Many Indian Nations and communities are seeking healing from historical trauma. One way Indian
peoples are healing is by connecting with those spiritual and cultural resources and strengths that
have traditionally restored balance to our lives.
One resource is the Medicine Wheel is a sacred symbol used by Plains tribes and others.
Conti, K. (2001). Medicine Wheel nutrition model. “Unpublished manuscript"
It represents all knowledge of the universe, and we can look to it for wisdom, healing and direction.
The circle represents life as a continuous cycle. The four lines crossing and intersecting within the
circle represent the sacred Four Directions (East, West, North and South). The four areas held
within the lines can represent different dimensions of creation and human experience, such as the
stages of human life or aspects of personhood. In other understandings of the Medicine Wheel, the
four areas can represent other aspects of reality, such as the four seasons, elements of the universe
or four sacred values: respect, generosity, fortitude and wisdom.
The Medicine Wheel focusing on the four aspects of self or personhood (mental, physical, emotional
and spiritual) shows us all these things are interconnected within the Circle of Life.
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Family Centered
The family is the center of the Nation. The Medicine Wheel showing the life stages of a person
(child, youth, adult, Elder) reflects that all members of a family are important in caring for each
other.
All family members are interconnected and affect each other. Caring for your own heart affects the
health and well being of your family members. The heart serves many roles, including helping to
sustain us physically, which affects us mentally, emotionally, and spiritually.
Notes:
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What Is a Heart Attack?
The Heart
A heart is a fist-sized muscle whose job is to pump blood through the body, picking up oxygen from
the lungs and distributing it to all of the cells of the body. It is remarkably well designed and
efficient, but certain circumstances can cause its normal function to be disrupted.
What Is a Heart Attack?
A heart attack happens when blood flow to a section of a heart muscle becomes blocked. If that
blood flow is not restored quickly, a part of the heart dies.
Heart attacks often happen because of a type of heart disease called coronary artery disease, or
CAD. Plaque (pronounced "plack") builds up over many years on the walls of the arteries that
supply blood and oxygen to the heart. It hardens the artery walls and blocks the flow of blood. The
narrowed arteries cannot deliver enough blood to maintain normal function of the parts of the body
they supply.
When blood flow to a part of the heart is completely blocked, a heart attack occurs. The part of
the heart muscle that is not receiving blood dies and is replaced by scar tissue. The longer the
blood flow to the heart is stopped, the greater the damage. Without quick treatment, it may cause
damage that we can’t see, or it could cause permanent or severe problems, even death.
Heart Attacks and Heart Disease in the Native Community
Heart attacks pose a serious threat to the Native community, but Native people may not be as
aware of the prevalence of heart attacks as they are of diabetes.
It is not just our Elders who need to recognize the signs and symptoms of a heart attack, it is all
generations of our people. Heart attacks can happen in younger adults as well. With the change in
diet young people under the age of 25 are experiencing heart disease and heart attacks.
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Signs and Symptoms of a Heart Attack
Signs and Symptoms for Men and Women
Knowing the signs and symptoms of heart attacks can help you save your life or the life of a family
member.
Men and women share some of the same heart attack symptoms. This can include:

Pain or discomfort in the jaw, neck or back.

Feeling weak, lightheaded or faint.

Chest discomfort or pain. Usually heart attacks involve discomfort in the center of the chest
that feels like pressure, squeezing, fullness, or pain. The discomfort may last more than a
few minutes, or may go away and come back again.

Pain or discomfort in the shoulders or in one or both arms.

Shortness of breath. You pant for breath or feel like you have to take deep breaths to get
enough air. This can occur with or without chest pain, or can come before chest pain.

Breaking out in a cold sweat. You suddenly start sweating or have cold, clammy skin.
Notes:
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Heart Attack Symptoms in Women
Women's heart attack symptoms are less predictable than men's. Women may experience all,
none, or some of the symptoms we just covered, and are more likely than men to not have any chest
pain during a heart attack. Some additional symptoms that a woman may experience during a
heart attack include:

Nausea (feeling sick to your stomach) or vomiting. It may feel like the stomach flu.

Fatigue or tiredness. You feel unusually worn out or exhausted.

Severe indigestion. This can feel like severe heartburn or stomach pain.

Depression can sometimes be a symptom.
Both men and women may also begin to notice symptoms before having a heart attack. These
symptoms can occur when a person is resting or active.
Notes:
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Calling 911
Importance of Calling 911
Heart attacks ARE treatable. A heart attack is most treatable when treatment is started within an
hour of the beginning of symptoms. Don't wait any more than five (5) minutes before calling 911 if
you suspect you or someone else is having a heart attack. When you act fast at the first signs of a
heart attack, you can save your life and limit damage to your heart.
Calling 911 for an ambulance is almost always the fastest and most effective way to receive
treatment.
What Is 911?
911 is a national emergency number that we can use to call for help from local police, fire, and
ambulance services; we can even use it to get information about poison control.
911 calls are free. You can call from any phone, no matter what kind it is: push button, rotary,
cellular/wireless, cordless, or pay phone.

When you call 911 from a payphone, you do not need to put in any money.

Disconnected phones can still connect to 911 services, so you can also call 911 no matter
whether or not your phone is in service.
All 911 dispatchers and answering points know how to respond to callers of all types, including kids
and those who are hearing/speech impaired. Kids should be taught to call 911 if there is an
emergency, and should know their names and addresses to give to responders.
What Happens When You Call 911?
Once you’ve dialed the numbers 9-1-1 into your phone, your call will automatically be directed to
a local Public Safety Answering Point, or PSAP. The workers at these answering points are all
trained professional staff whose job it is to identify and respond to emergencies.

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Stay calm and state your emergency.
Heart of Many Nations: Heart Attack Prevention and Response in Native Communities
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
They will ask you questions to determine what exactly is going on and what help is needed.

As they are asking you questions, they are also contacting the closest emergency response
teams to send your way.

Be prepared to provide information like your name, phone number, address, and anything
else they may need to know.

Don't hang up until they say it is okay to.

If you are unable to communicate, call 911 and stay on the line. Don't hang up! The
operator will understand that there is an emergency, will figure out where you are with the
satellite technology and will send help your way.
Notes:
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Risk Factors
Knowing your risk factors can empower you to be proactive in preventing heart attacks in yourself
and others. There are two kinds of risk factors, ones we can't change and ones we can.
Risk Factors We Can't Change
Risk factors that we can't change, include:

Increasing age. Most people who die from heart disease are 65 or older.

Family history of heart disease.

Post-menopausal.

Previous heart attack.
Notes:
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Risk Factors We Can Change
Here are the risk factors that we can change. They include:

High cholesterol

High blood pressure

Non-sacred use of tobacco

Diabetes

Diet high in meats, cheeses, and fried foods and low in fruits and vegetables.

Physical inactivity

Being overweight or obese

Stress
Notes:
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What Is Cholesterol?
Cholesterol: a waxy fat-like substance that is produced by the liver and is necessary to function
normally.
Our livers naturally make enough cholesterol for the body's needs. However, diets high in
saturated and trans fats can add to the cholesterol already in our bodies.
Three types of cholesterol are:

LDL cholesterol (known as “bad” cholesterol) can build up on the inside of artery walls. The
deposits, called plaque, narrow the arteries. This condition is called atherosclerosis. Higher
LDL cholesterol means higher risk of heart disease.

HDL cholesterol (known as "good" cholesterol) helps prevent arteries from becoming
clogged. Higher HDL cholesterol generally means lower risk of heart disease.

Total cholesterol is the amount of HDL and LDL in the blood added together.
Diets high in saturated fats and trans fat can lead to high overall cholesterol levels and especially
high “bad” cholesterol levels. Saturated fat is found in pork, fatty bee f processed meats such as
hotdogs, poultry with skin, lard, and dairy products made from whole or 2% milk such as butter,
cream, and cheese. It is also found in many packaged baked goods and fried foods. Palm oil and
coconut oil contain saturated fats as well. Trans fat is common in commercial baked goods like
crackers, cookies and cakes.
Reducing how much saturated fat and trans fat you eat reduces your bad cholesterol.
You can also raise your good cholesterol by:

Eating a balanced diet.

Eating more fiber: found in oats, fruits, vegetables, and legumes.

Increasing the healthy fats in your diet: avocados, olive oil, canola oil, and peanut butter,
plus fish and other foods containing omega-3 fatty acids.
Exercising regularly, quitting smoking, and losing weight if you are overweight all also help in
raising HDL levels.
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What Are Appropriate Cholesterol Levels?
Cholesterol is measured with a simple blood test, often called a lipid profile. The lipid profile will
give you four numbers.
Healthy cholesterol levels are when:
 Your LDL (low density lipoprotein or your “bad” cholesterol) is less than 100.

Your HDL cholesterol (high-density lipoprotein, or your "good" cholesterol) is greater than
40 for men or greater than 50 for women. A level greater than 60 is considered protective
against heart disease; and,

Your total cholesterol is less than 200.
If your total cholesterol or LDL cholesterol is high, or HDL is low, your doctor will probably want to
monitor it more closely and will give you advice about how to manage it. This is especially true if
you have been diagnosed with diabetes or coronary artery disease.
Risk Factors for High Cholesterol
Many of the factors that contribute to high cholesterol are similar to the ones that increase our risk
of heart attacks. They include:

A diet high in meats, cheeses, and fried foods and that is low in fruits and vegetables.

Older age

Being overweight or obese

Family history
Notes:
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What Is High Blood Pressure?
Blood pressure is the force of the blood flowing through your body and pushing against the walls of
your arteries as your heart pumps out blood. High blood pressure means that this pressure has
risen and stayed there, which increases the work that your heart has to do and damages your body
over time.
High blood pressure can increase your risk of heart attack, stroke, kidney failure and heart failure.
There are often no symptoms to let you know that you have a high blood pressure, which is why it is
important to monitor your risk factors and have your blood pressure checked regularly.
Notes:
What Are Appropriate Blood Pressure Levels?
Healthy blood pressure: 120/80 mmHg or lower.
If your blood pressure is above 120/80 mmHg, your risk for health problems rises. If your systolic
(top) number is over 140, or your diastolic (bottom) number is over 90, you have high blood
pressure.
If you have high blood pressure or are close to getting it, you can take steps to control it by
working on a healthy lifestyle, taking your medications as prescribed, and regularly seeing your
healthcare provider.
Notes:
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Risk Factors for High Blood Pressure
Some of the factors that contribute to having high blood pressure include:

Being overweight or obese

Sodium intake (the amount of salt you take in)

A lack of physical activity

Heavy alcohol consumption

Non-traditional tobacco use

Diabetes and other conditions
Notes:
There are also factors that we can't control that contribute to having high blood pressure. These
factors include:

Older age

Family history
Notes:
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Sacred Tobacco Use
In many Native traditions, tobacco is sacred, and given by the Creator for use only for spiritual
purposes. These purposes include medicine, prayer, purification, and communicating thoughts and
feelings to other beings and/or the spirit world. Tobacco has been used in sacred ways by
American Indians for over 18,000 years.
Tobacco is a factor contributing to heart disease. Many Native people view returning to the
spiritual tradition of using tobacco in a ceremonial way as vitally important to health of Native
communities.
Returning to the sacred use of tobacco with the guidance of spiritual leaders and Elders, rather than
continuing the non-sacred use of it, as in smoking cigarettes, will promote the health of a person in
all aspects.
Notes:
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Nutrition
As we discussed earlier, colonization of our people and our lands has resulted in an imbalance in
our communities and in ourselves.
But across the Indian Nations, there are many examples of people working to protect or restore
traditional food practices. They are planting gardens of traditional foods, teaching traditional
ways of preparing foods, increasing standards for our quality of water, establishing game
reserves, and re-claiming traditional land to use for making food.
The Woodlands Foodway Traditional Model and the Four Winds Model
A challenge in healing our bodies and our hearts is learning how to live in a modern time while still
attempting to eat in a way that honors our traditional lifestyle. The Woodlands Foodway
Traditional Model reflects the key parts of our ancestor’s diets: Four legged and Finned, Gathered
Ones, Harvested Crops, and Water.
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Now, that the traditional model has been updated for modern times: It is based on the Medicine
Wheel and called the Four Winds Model. It reflects the traditional make-up of our diet and our
traditional practices while including both conventional and modern foods. It was developed by
Kibbe Conti, Lakota, a Native nutritionist, and Elder Bob Chasing Hawk, Cheyenne River Souix.
Image sources: Conti, K.M. (2006). Diabetes prevention in Indian Country: Developing nutrition
models to tell the story of food-system change. J Transcult Nurs, 17, 234-245.
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
The West Wind brings the life giving rains: water, teas, milk, and sugar-free and alcoholfree drinks.

The North Wind is represented by the strength and endurance of the Buffalo: protein
sources from lean animal food products, including seafood, buffalo, turkey, chicken without
the skin, loin cuts of beef/pork, 90% lean ground beef, eggs, and cheese.

The East Wind represents the dawn of a new day: berries, fruits, juices, and non-starchy
vegetables.

The South Wind is represented by the warm summer wind: grains and starchy vegetables,
including breads, noodles, cereal, corn, beans, potato, squash, wheat, rye, oats, barley and
rice.
Notes:
All four of these food groups are important to create a balanced meal and a healthy diet. No one
group should dominate. The Four Winds Model can be used to create balance on our plate, and
balance in our lives.
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A few more things to keep in mind:

Healthy, modestly active adults need 1800 to 2200 calories.

To create a balance meal, practice portion sizes: Meat portions are the size of the palm of
your hand. Fruit or juice portions are four to six ounces. Vegetables should be half a cup to
a full cup. Grains and starches should be about one-fourth to one-third of your meal.

Try to have protein at least twice a day. Breakfast doesn't always have to include a North,
or protein, food.

When grocery shopping, slow down, look at all of the sections, and read the food labels.

Prepare fresh meals as often as possible.
Notes:
Balanced eating can help us reach or maintain a healthy weight, prevent diabetes, lower
cholesterol and blood pressure, reduce stress, and reduce our risk of heart attack. And, when we
eat healthfully and encourage others to do the same, we can pass this knowledge and the healing
that comes with it on to our family members and future generations.
Notes:
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